J ALLERGY CLIN IMMUNOL

VOLUME 133, NUMBER 2

Abstracts AB43

SATURDAY

154 Use Of Asthma Control Indicators In Measuring Efficacy Of

Inhaled Corticosteroids In Asthmatic Smokers: A SystematicReview

Ms. Claire E. Hayes, MPH, CHES, AE-C, Mr. Henry Nuss, PhD; Loui-

siana State University Health Sciences Center School of Public Health,

New Orleans, LA.

RATIONALE: Across studies investigators have reached competing

conclusions regarding the effectiveness of inhaled corticosteroids (ICS)

on improving asthma control in smokers. We completed a systematic

review of literature on the use of asthma control indicators to 1. Determine

how current research measures efficacy of ICS in asthmatic smokers as

well as to 2. Determine if current research supports claims that asthmatic

smokers are resistant to the effects of ICS.

METHODS: On-line databases PubMed, CINAHL, and PsycINFO were

searched using terms relating to asthma, tobacco use, and corticosteroid

effectiveness. Eligibility criteria included: Articles published between

2005 and 2013, English language, human subjects, adults (19 and older),

and studies using at least one indicator of control as a measure of ICS

effectiveness. The prevalence of asthma control indicators as well as

outcomes of individual studies were compiled and analyzed to determine

efficacy of ICS in patients.

RESULTS: Twelve studies met search criteria. Seven of these used only 1

indicator tomeasure asthma control in smokers.Additionally, ICSwas found

to be effective for smokers in only 4 of these studies. ICS was found to be

effective in all studies which used at least 5 indicators to measure control.

CONCLUSIONS: Inhaled corticosteroids are shown to improve asthma in

smokers whenmultiple control indicators are used to measure effectiveness.

Future studies should 1. Evaluate the effectiveness of ICS using multiple

indicators of control, as well as 2. Monitor patient adherence to ICS in

studies when determining appropriate asthma therapies for smokers.

155 Evaluation Of a Medication Adherence Estimator SurveyCompared To Exhaled Nitric Oxide (FeNO) Levels andAsthma Control Test In Difficult-To-Treat/Severe PediatricAsthma Patients

Jigar Patel1, Vanessa Y. Cavero, MD2, Amy Perkins, MS2, Heather

Minto, MD2, Maripaz B. Morales, MD2; 1Department of Pediatrics,

Eastern Virginia Medical School, Norfolk, VA, 2Children’s Hospital of

The King’s Daughters, Norfolk, VA.

RATIONALE: Many difficult-to-treat/severe pediatric asthma patients

are non-adherent to inhaled corticosteroid (ICS) therapy, resulting in

increased hospitalizations and emergency department visits as well as

reduced lung function. There is a need to develop a practical clinical tool to

assess adherence.

METHODS: CHKD Allergy/Immunology Clinic recruited 45 partici-

pants for a prospective observational study. Inclusion criteria: 7-18 years

old, diagnosed asthma, prescribed high dose ICS (>_1000 mcg/day).

Participants and parents completed Asthma Control Test (ACT) and

Adherence Estimator (developed by Merck and validated in adult chronic

disease population to assess medication non-adherence risk). FeNO was

measured. Charts were reviewed for demographics and medications. Data

were analyzed to obtain descriptive statistics and Spearman rank correla-

tion coefficients (rho).

RESULTS: 53.3% (n524) of subjects had a high FeNO level (>_20ppb)

and 62.2% (n528) had poorly controlled asthma according to ACT;

however, only 8.9% (n54) were high risk for non-adherence. 55.6%

(n525)were also onXolair step-up therapy. Therewas no significant linear

relationship between FeNO and Adherence Score (rho5-0.01) or between

FeNO and ACT Score (rho5-0.12). These coefficients were neither

statistically significantly different from zero nor greater than -0.55 (all

P>0.05). There was a very weak, negative association between AdherenceScore and ACT Score; rho5-0.32 was statistically significantly different

from zero (P50.03) but was not significantly greater than -0.55 (P>0.05).

CONCLUSIONS: Future studies should focus on constructing a medica-

tion adherence questionnaire that can be validated in a larger pediatric

asthma population.

156 An Assessment Of Infection Rates and Health Resource UseAmong Primary Immunodeficiency Disorder (PIDD) PatientsPrior To Diagnosis

Dr. Chris Rabbat, PhD, Ms. Diane Ito, MA, Ms. Yan Xiong, MS,

Dr. Josephine Li-McLeod, PhD; Baxter Healthcare Corporation, Westlake

Village, CA.

RATIONALE: It is hypothesized that undiagnosed PIDD may burden

both the patient with repeated infections and the healthcare system with

significant service utilization. This analysis assessed infection rates and

healthcare utilization among patients in the years leading up to a PIDD

diagnosis.

METHODS: This retrospective analysis utilized the Truven Marketscan

Database, 2002-2012. Patients who had at least 1 inpatient or ER diagnosis

or at least 2 outpatient diagnoses of PIDD (279.xx) and at least one of the

following PIDD diagnoses: 279.04, 279.01, 279.05, or 279.06 and 5 years

of continuous health plan enrollment were identified. The first PIDD

diagnosis (279.xx) was identified as the index date and data preceding the

index date were examined. Incidence rates of pneumonia, sinusitis,

bronchitis, otitis, as well as hospitalizations, outpatient visits and

outpatient drug utilization were analyzed.

RESULTS: 1388 patients were undiagnosed with PIDD for at least 5

years, of these, 84 were undiagnosed for at least 10 years, suggesting that

many patients are undiagnosed for years. The average percent increase in

rates of pneumonia, sinusitis, bronchitis and otitis per year over the 10

years prior to diagnosis were 39%, 20.4%, 20.2%, 14.2%, respectively.

Hospitalizations, outpatient visits and outpatient drug utilization increased

on average 29.1%, 10.5% and 5.3% per year, respectively during the same

time frame. This considerable increase in infections and hospitalizations

suggests the condition may be increasing in severity over time prior to

diagnosis.

CONCLUSIONS: The results suggest a more timely diagnosis of PIDD

may substantially ease the burden for both patients and the healthcare

system.

157 A Comparison Of Costs Between Outpatient Hospital, Clinicand Home Settings For Intravenous Immunoglobulin (IVIG)Infusions

Dr. Xiaolan Ye, PhD, Ms. Diane Ito, MA, Ms. Yan Xiong, MS,

Dr. Josephine Li-McLeod, PhD; Baxter Healthcare Corporation, Westlake

Village, CA.

RATIONALE: Home-based infusion of IVIG therapymay be beneficial in

terms of reduced costs compared to the outpatient hospital (OH) or clinic

setting. This analysis assessed cost differences between infusions con-

ducted at home versus OH or clinic using data from a large, commercial

medical claims database.

METHODS: Patients who had at least 3 months of continuous IVIG

claims were identified using J codes from the Truven Marketscan

Database, years 2002 -2012. Those who switched their infusion site of

care from the OH or the clinic to the home setting and had 3 or more IVIG

claims in each site of care were identified. Costs of care were compared

between the home and OH or clinic setting. Monthly costs were calculated

for each site, and the ratio between monthly cost at home and monthly cost

in the OH or clinic was calculated for each patient. Signed rank test was

used to determine statistical significance between sites.

RESULTS: There were 83 and 79 patients who switched their IVIG

infusion sites between clinic and home or OH and home, respectively.

Switching from OH to home infusions resulted in significantly lower

median costs ($6,916 v $4,188). The median home-to-OH cost ratio was

0.61 (p<0.0001), indicating the costs of care for the home-based infusions

were significantly less than the OH setting. The differences in costs

between clinic and home were not significant.

CONCLUSIONS: In this study, switching patients on IVIG treatment

from the OH to the home setting resulted in significant cost savings.